The effect of fresubin diabetes on inflammatory factors and prognosis in patients with diabetes and mechanical ventilation / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the effect of enteral nutrition emulsion (fresubin diabetes) on inflammatory factors and prognosis in patients with diabetes and mechanical ventilation (MV). Methods Sixty-six patients with diabetes and MV admitted to Lishui Hospital of Traditional Chinese Medicine from June 2014 to December 2016 were enrolled, and they were divided into an observation group and a control group according to random number table, 33 cases in each group. Active treatment of the primary disease, maintenance of water and electrolyte balance, active control of infection, protamine biosynthesis of human insulin injection to control blood glucose and other treatment were given to both groups. After 24 hours of MV, enteral nutrition suspension (nutrison fibre) was evenly dripped into the control group through a nasogastric tube, and fresubin diabetes was evenly dripped with the same method as above into the observation group. After treatment for 2 weeks, the average values of daily blood glucose, of blood glucose fluctuation and daily total insulin dosage of two groups were calculated; the differences in procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and serum albumin (ALB), prealbumin (PA) and transferrin (TF) were compared before and after treatment in the two groups; the duration of MV, stay time in ICU, and 2-week MV withdrawal rate were observed in the two groups. Results During nutritional therapy, there was no significant difference in the average daily blood glucose level between observation group and control group (mmol/L 8.62±2.65 vs. 9.70±3.43, P > 0.05), however, in the observation group, the average daily blood glucose fluctuation value (mmol/L 3.13±1.09 vs. 5.68±1.40), and the daily total insulin dosage (U/d 31.93±4.93 vs. 43.50±5.31) were significantly lower than those of the control group (both P < 0.05). After treatment, PCT and hs-CRP in both groups were significantly lower than those before treatment, and the degrees of decrease in observation group were more significant than those in the control group [PCT (μg/L)2.81±1.03 vs. 5.95±1.57, hs-CRP (mg/L) 4.41±2.01 vs. 11.46±4.05, all P < 0.05]. After treatment, the levels of ALB, PA and TF were significantly higher than those before treatment [ALB (g/L) the control group was 37.98±3.49 vs. 30.50±3.44, the observation group was 37.88±3.47 vs. 30.48±3.34; PA (mg/L) the control group was 188.60±12.66 vs. 130.22±11.33, the observation group was 184.42±12.95 and 133.50±11.91; TF (mg/L) the control group was 2.71±1.01 vs. 2.07±0.86, the observation group was 2.69±1.02 vs. 2.08±0.90, all P < 0.05]; however, there were no statistical significant differences between the two groups (all P > 0.05). The MV time (days 7.29±3.65 vs. 10.70±4.43) and ICU stay (days 11.13±3.09 vs. 15.48±4.40) in the observation group were significantly lower than those in the control group (both P < 0.05), and 2-week MV withdrawal rate was significantly higher than that of the control group [69.70% (23/33) vs. 39.39% (13/33), P < 0.05]. Conclusion Fresubin diabetes can meet the nutritional needs of diabetic patients with MV, in the aspects of controlling blood sugar, maintaining stable blood sugar levels and reducing inflammation, the therapeutic effect of fresubin diabetes is better than that of nutrison fibre, thus fresubin diabetes may better improve the prognosis of patients with diabetes.